Some Perspectives on Deinstitutionalization

Abstract

The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization-a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved.

Usefulness of the UCSD performance-based skills assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia

“…The development of a "gold standard" measure that captures these domains and is capable of accurately predicting the ability to reside independently in the community is needed for healthcare providers and family members who must make decisions regarding safe living situations for patients (e.g., whether to discharge an inpatient with schizophrenia to a B&C facility or independent living environment). This becomes particularly important when considering the "deinstitutionalization" of people with mental illness over the past 50 years, including the release of persons residing in psychiatric hospitals to alternative facilities in the community (Lamb & Bachrach, 2001). Indeed, Lamb and Bachrach (2001) report that between 1955 and 1998, the number of occupied state hospital beds in the United States was reduced from 339 per 100,000 population to 21 per 100,000 population.…”

“…This becomes particularly important when considering the "deinstitutionalization" of people with mental illness over the past 50 years, including the release of persons residing in psychiatric hospitals to alternative facilities in the community (Lamb & Bachrach, 2001). Indeed, Lamb and Bachrach (2001) report that between 1955 and 1998, the number of occupied state hospital beds in the United States was reduced from 339 per 100,000 population to 21 per 100,000 population. In California, the pioneer in deinstitutionalization, this number was 3 per 100,000 (Lamb et al, 2001).…”

“…Indeed, Lamb and Bachrach (2001) report that between 1955 and 1998, the number of occupied state hospital beds in the United States was reduced from 339 per 100,000 population to 21 per 100,000 population. In California, the pioneer in deinstitutionalization, this number was 3 per 100,000 (Lamb et al, 2001).…”

Teamwork Within Mental Health Services in Ireland: Resource Paper

“…Their typically more difficult-to-treat profiles are due to a variety of factors including exacerbation of symptoms and problematic behaviours brought about by easy access to alcohol and other illicit drugs, and a high degree of co-morbidity. 151 While only a small minority, these individuals can find it challenging to sustain themselves in the community and can experience frequent and often involuntary admission for lengthy periods of time. 152 Due to their need for long-term specialised care, they are difficult to manage in community facilities.…”

Acute inpatient psychiatry in England: an old problem and a new priority

“…As in other developed, Western Countries, the locus of mental health care in England has shifted progressively over the past 50 years (Lamb & Bachrach, 2001). Before the 1960s, services were located predominantly in large psychiatric hospitals that were often geographically remote from the population they served.…”